BILL NUMBER: AB 1174 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JANUARY 6, 2014
AMENDED IN ASSEMBLY APRIL 9, 2013
AMENDED IN ASSEMBLY MARCH 21, 2013
INTRODUCED BY Assembly Members Bocanegra and Logue
FEBRUARY 22, 2013
An act to amend Sections 1752.4, 1753.5, 1753.6, and
1910 , and 1926 of, to amend, repeal, and add Section
1753.6 of , and to add, repeal, and add Sections 1753.55,
1910.5, and 1926.05 of, the Business and Professions Code, and
to add Section 14132.726 to amend Section
14132.725 of the Welfare and Institution
Institutions Code, relating to oral health.
LEGISLATIVE COUNSEL'S DIGEST
AB 1174, as amended, Bocanegra. Dental professionals:
teledentistry under Medi-Cal.
(1) Existing law, the Dental Practice Act, establishes the Dental
Board of California. Existing law creates, within the jurisdiction of
the board, a Dental Assisting Council that is responsible for the
regulation of dental assistants, registered dental assistants, and
registered dental assistants in extended functions and a Dental
Hygiene Committee of California, that is responsible for the
regulation of registered dental hygienists, registered dental
hygienists in alternative practice, and registered dental hygienists
in extended functions. Existing law governs the scope of practice for
those professionals.
This bill would authorize a registered dental assistant who
has completed a specified educational program to determine
which radiographs to perform if he or she has completed a
specified educational program . The bill would authorize a
registered dental assistant in extended functions licensed on or
after January 1, 2010, to place interim therapeutic
restorations, as defined, pursuant to the order, control, and full
professional responsibility of a licensed dentist, as specified. The
bill would authorize a registered dental hygienist to, after
submitting to the committee evidence of satisfactory completion of a
course of instruction approved by the committee, determine which
a registered dental hygienist, and a registered dental
hygienist in alternative practice to choose radiographs
to perform and place interim therapeutic
protective restorations upon the order
of a licensed dentist . , as
specified.
(2) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services,
including certain dental services, as specified. Existing law
provides that, to the extent that federal financial participation is
available, face-to-face contact between a health care provider and a
patient is not required under the Medi-Cal program for
"teleophthalmology and teledermatology by store and forward," as
defined to mean the asynchronous transmission of medical information
to be reviewed at a later time by a licensed physician or
optometrist, as specified, at a distant site.
This bill would enact similar provisions relating to the use of
teledentistry, as defined, under the Medi-Cal program. The bill would
provide that, to the extent that federal financial participation is
available, face-to-face contact between a health care provider and a
patient shall not be required under the Medi-Cal program for
"teledentistry by store and forward." The bill would define that term
to mean an asynchronous transmission of dental information to be
reviewed at a later time by a licensed dentist at a distant site,
where the dentist at the distant site reviews the dental information
without the patient being present in real time, as defined and as
specified. The bill would also provide that dentist participation in
services provided at an intermittent clinic, as defined, through the
use of telehealth, as defined, shall be considered a billable
encounter under Medi-Cal. The bill would also require, on or before
January 1, 2017, the department to report to the Legislature the
number and type of services provided, and the payments made related
to the application of teledentistry, as specified.
This bill would additionally provide that face-to-face contact
between a health care provider and a patient is not required under
the Medi-Cal program for teledentistry by store and forward, as
defined.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1752.4 of the Business and Professions Code is
amended to read:
1752.4. (a) A registered dental assistant may perform all of the
following duties:
(1) All duties that a dental assistant is allowed to perform.
(2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
(3) Apply and activate bleaching agents using a nonlaser
light-curing device.
(4) Use of automated caries detection devices and materials to
gather information for diagnosis by the dentist.
(5) Obtain intraoral images for computer-aided design (CAD),
milled restorations.
(6) Pulp vitality testing and recording of findings.
(7) Place bases, liners, and bonding agents.
(8) Chemically prepare teeth for bonding.
(9) Place, adjust, and finish direct provisional restorations.
(10) Fabricate, adjust, cement, and remove indirect provisional
restorations, including stainless steel crowns when used as a
provisional restoration.
(11) Place postextraction dressings after inspection of the
surgical site by the supervising licensed dentist.
(12) Place periodontal dressings.
(13) Dry endodontically treated canals using absorbent paper
points.
(14) Adjust dentures extra-orally.
(15) Remove excess cement from surfaces of teeth with a hand
instrument.
(16) Polish coronal surfaces of the teeth.
(17) Place ligature ties and archwires.
(18) Remove orthodontic bands.
(19) All duties that the board may prescribe by regulation.
(b) A registered dental assistant may only perform the following
additional duties if he or she has completed a board-approved
registered dental assistant educational program in those duties, or
if he or she has provided evidence, satisfactory to the board, of
having completed a board-approved course in those duties.
duties:
(1) Remove excess cement with an ultrasonic scaler from
supragingival surfaces of teeth undergoing orthodontic treatment.
(2) The allowable duties of an orthodontic assistant permitholder
as specified in Section 1750.3. A registered dental assistant shall
not be required to complete further instruction in the duties of
placing ligature ties and archwires, removing orthodontic bands, and
removing excess cement from tooth surfaces with a hand instrument.
(3) The allowable duties of a dental sedation assistant
permitholder as specified in Section 1750.5.
(4) The application of pit and fissure sealants.
(5) Determine which radiographs to perform.
(c) Except as provided in Section 1777, the supervising licensed
dentist shall be responsible for determining whether each authorized
procedure performed by a registered dental assistant should be
performed under general or direct supervision.
SEC. 2. Section 1753.5 of the Business and
Professions Code is amended to read:
1753.5. (a) A registered dental assistant in extended functions
licensed on or after January 1, 2010, is authorized to perform all
duties and procedures that a registered dental assistant is
authorized to perform as specified in and limited by Section 1752.4,
and those duties that the board may prescribe by regulation.
(b) A registered dental assistant in extended functions licensed
on or after January 1, 2010, is authorized to perform the following
additional procedures under direct supervision and pursuant to the
order, control, and full professional responsibility of a licensed
dentist:
(1) Conduct preliminary evaluation of the patient's oral health,
including, but not limited to, charting, intraoral and extra-oral
evaluation of soft tissue, classifying occlusion, and myofunctional
evaluation.
(2) Perform oral health assessments in school-based, community
health project settings under the direction of a dentist, registered
dental hygienist, or registered dental hygienist in alternative
practice.
(3) Cord retraction of gingiva for impression procedures.
(4) Size and fit endodontic master points and accessory points.
(5) Cement endodontic master points and accessory points.
(6) Take final impressions for permanent indirect restorations.
(7) Take final impressions for tooth-borne removable prosthesis.
(8) Polish and contour existing amalgam restorations.
(9) Place, contour, finish, and adjust all direct restorations.
(10) Adjust and cement permanent indirect restorations.
(11) Other procedures authorized by regulations adopted by the
board.
(c) All procedures required to be performed under direct
supervision shall be checked and approved by the supervising licensed
dentist prior to the patient's dismissal from the office.
(d) (1) A registered dental assistant in extended functions
licensed on or after January 1, 2010, is authorized to place interim
therapeutic restorations, defined as the removal of caries using hand
instruments and placement of an adhesive restorative material, upon
the order of the supervising dentist under general supervision,
except as authorized pursuant to paragraph (3), and pursuant to the
order, control, and full professional responsibility of a licensed
dentist.
(2) A registered dental assistant in extended function may only
perform the functions authorized pursuant to paragraph (1) if he or
she has completed a board-approved registered dental assistant in
extended function education program in performing those functions, or
if he or she has provided evidence, satisfactory to the board, of
having completed a board-approved course in those functions.
(3) The supervising licensed dentist shall be responsible for
determining whether the functions authorized pursuant to paragraph
(1) may be performed under general or direct supervision.
SEC. 2. Section 1753.55 is added to the
Business and Professions Code , to read:
1753.55. (a) For the purposes of this section, the following
definitions shall apply:
(1) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
(2) "Course" means a board-approved course preparing a registered
dental assistant in extended functions to perform the duties
described in subdivision (b).
(3) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
through electronic media, home study materials, or live lecture
methodology if the provider has submitted that content to the board
for approval.
(4) "Interim therapeutic restoration" means a direct provisional
restoration placed to stabilize the tooth until a licensed dentist
diagnoses the need for further definitive treatment.
(5) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods.
(6) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(7) "Program" means a board-approved registered dental assistant
in extended functions educational program.
(b) In addition to the duties specified in Section 1753.5, a
registered dental assistant in extended functions licensed on or
after January 1, 2010, is authorized to perform both of the following
additional duties pursuant to the order, control, and full
professional responsibility of a supervising dentist:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(A) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(B) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
paragraph (4) of subdivision (a), that compromise the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary. The protective restorations shall be placed only in
accordance with both of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(ii) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c) The functions described in subdivision (b) may be performed by
a registered dental assistant in extended functions only after
completion of a program that includes training in performing those
functions, or after providing evidence, satisfactory to the board, of
having completed a board-approved course in those functions.
(1) A registered dental assistant in extended functions who has
completed the prescribed training in the Health Workforce Pilot
Project #172 established by the Office of Statewide Health Planning
and Development pursuant to Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107 of the Health and
Safety Code shall be deemed to have satisfied the requirement for
completion of a course of instruction approved by the board.
(2) In addition to the instructional components described in
subdivision (d) or (e), a program shall contain both of the
instructional components described in this paragraph:
(A) The course shall be established at the postsecondary
educational level.
(B) All faculty responsible for clinical evaluation shall have
completed a one-hour methodology course in clinical evaluation or
have a faculty appointment at an accredited dental education program
prior to conducting evaluations of students.
(d) A program or course to perform the duties described in
paragraph (1) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency making decisions about which radiographs
to take to facilitate an evaluation by a dentist, but shall in no
event be less than six hours, including at least two hours of
didactic training, at least two hours of guided laboratory simulation
training, and at least two hours of examination using simulated
cases.
(2) Didactic instruction shall consist of instruction on both of
the following topics:
(A) Guidelines for radiographic decisionmaking prepared by the
American Dental Association and other professional dental
associations.
(B) Specific decisionmaking protocols that incorporate information
about the patient's health and radiographic history, the time span
since previous radiographs were taken, the availability of previous
radiographs, the general condition of the mouth including the extent
of dental restorations present, and visible signs of abnormalities,
including broken teeth, dark areas, and holes in teeth.
(3) Laboratory instruction shall consist of simulated
decisionmaking using case studies containing the elements described
in paragraph (2). There shall be at least one instructor for every 14
students who are simultaneously engaged in laboratory instruction.
(4) Examinations shall consist of decisionmaking where students
make decisions and demonstrate competency to faculty on case studies
containing the elements described in paragraph (2).
(e) A program or course to perform the duties described in
paragraph (2) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency in the application of protective
restorations, including interim therapeutic restorations, but shall
in no event be less than 16 clock hours, including at least four
hours of didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training.
(2) Didactic instruction shall consist of instruction on all of
the following topics:
(A) Pulpal anatomy.
(B) Theory of adhesive restorative materials used in the placement
of adhesive protective restorations related to mechanisms of bonding
to tooth structure, handling characteristics of the materials,
preparation of the tooth prior to material placement, and placement
techniques.
(C) Criteria that dentists use to make decisions about placement
of adhesive protective restorations including all of the following:
(i) Patient factors:
(I) The patient's American Society of Anesthesiologists Physical
Status Classification is Class III or less.
(II) The patient is cooperative enough to have the restoration
placed without the need for special protocols, including sedation or
physical support.
(III) The patient, or responsible party, has provided consent for
the procedure.
(IV) The patient reports that the tooth is asymptomatic, or if
there is mild sensitivity to sweet, hot, or cold that the sensation
stops within a few seconds of the stimulus being removed.
(ii) Tooth factors:
(I) The cavity is accessible without the need for creating access
using a dental handpiece.
(II) The margins of the cavity are accessible so that clean
noncarious margins can be obtained around the entire periphery of the
cavity with the use of hand instruments.
(III) The depth of the lesion is more than two millimeters from
the pulp on radiographic examination or is judged by the dentist to
be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic.
(IV) The tooth is restorable and does not have other significant
pathology.
(D) Criteria for evaluating successful completion of adhesive
protective restorations including all of the following:
(i) The restorative material is not in hyperocclusion.
(ii) There are no marginal voids.
(iii) There is minimal excess material.
(E) Protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations including
situations requiring immediate referral to a dentist.
(F) Protocols for followup of adhesive protective restorations.
(3) Laboratory instruction shall consist of placement of adhesive
protective restorations where students demonstrate competency in this
technique on typodont teeth.
(4) Clinical instruction shall consist of experiences where
students demonstrate placement of adhesive protective restorations
under direct supervision of faculty.
(f) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 3. Section 1753.55 is added to the
Business and Professions Code , to read:
1753.55. (a) For the purposes of this section, "interim
therapeutic restoration" means a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment.
(b) In addition to the duties specified in Section 1753.5, a
registered dental assistant in extended functions licensed on or
after January 1, 2010, is authorized to perform both of the following
additional duties pursuant to the order, control, and full
professional responsibility of a supervising dentist:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(A) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(B) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations through interim therapeutic
restorations that remove soft material from the tooth using only hand
instrumentation, without the use of rotary instrumentation, and
subsequent placement of an adhesive restorative material, without the
use of local anesthesia. The protective restorations shall only be
placed subject to both of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(ii) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c) This section shall become operative on January 1, 2018.
SEC. 3. SEC. 4. Section 1753.6 of
the Business and Professions Code is amended to read:
1753.6. (a) Each person who holds a license as a registered
dental assistant in extended functions on the operative date of this
section may only perform those procedures that a registered dental
assistant is allowed to perform as specified in and limited by
Section 1752.4, and the procedures specified in paragraphs (1) to
(6), inclusive, until he or she provides evidence of having completed
a board-approved course in the additional procedures specified in
paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision
(b) , and paragraph (1) of subdivision (d), of
Section 1753.5, and an examination as specified in Section 1753.4:
(1) Cord retraction of gingiva for impression procedures.
(2) Take final impressions for permanent indirect restorations.
(3) Formulate indirect patterns for endodontic post and core
castings.
(4) Fit trial endodontic filling points.
(5) Apply pit and fissure sealants.
(6) Remove excess cement from subgingival tooth surfaces with a
hand instrument.
(b) This section shall become operative on January 1, 2010.
(b) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 5. Section 1753.6 is added to the
Business and Professions Code , to read:
1753.6. (a) Each person who holds a license as a registered
dental assistant in extended functions on the operative date of this
section may only perform those procedures that a registered dental
assistant is allowed to perform as specified in and limited by
Section 1752.4, and the procedures specified in paragraphs (1) to
(6), inclusive, until he or she provides evidence of having completed
a board-approved course in the additional procedures specified in
paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision
(b) of Section 1753.5, procedures specified in Section 1753.55, and
an examination as specified in Section 1753.4:
(1) Cord retraction of gingiva for impression procedures.
(2) Take final impressions for permanent indirect restorations.
(3) Formulate indirect patterns for endodontic post and core
castings.
(4) Fit trial endodontic filling points.
(5) Apply pit and fissure sealants.
(6) Remove excess cement from subgingival tooth surfaces with a
hand instrument.
(b) This section shall become operative on January 1, 2018.
SEC. 4. SEC. 6. Section 1910 of the
Business and Professions Code is amended to read:
1910. A registered dental hygienist is authorized to perform the
following procedures under general supervision:
(a) Preventive and therapeutic interventions, including oral
prophylaxis, scaling, and root planing.
(b) Application of topical, therapeutic, and subgingival agents
used for the control of caries and periodontal disease.
(c) The taking of impressions for bleaching trays and application
and activation of agents with nonlaser, light-curing devices.
(d) The taking of impressions for bleaching trays and placements
of in-office, tooth-whitening devices.
(e) After submitting to the committee evidence of satisfactory
completion of a course of instruction approved by the committee, the
following:
(1) Determine which radiographs to perform.
(2) Place interim therapeutic restorations, defined as the removal
of caries using hand instruments and placement of an adhesive
restorative material, upon the order of a licensed dentist.
SEC. 5. Section 14132.726 is added to the
Welfare and Institutions Code, to read:
14132.726. (a) To the extent that federal financial participation
is available, face-to-face contact between a health care provider
and a patient shall not be required under the Medi-Cal program for
teledentistry by store and forward. Services appropriately provided
through the store and forward process are subject to billing and
reimbursement policies developed by the department.
(b) A patient receiving teledentistry by store and forward shall
be notified of the right to receive interactive communication with
the distant dentist, and shall receive an interactive communication
with the distant dentist, upon request. If requested, communication
with the distant dentist may occur either at the time of the
consultation, or within 30 days of the patient's notification of the
results of the consultation.
(c) Dentist participation in services provided at an intermittent
clinic, as defined in Section 1206 of the Health and Safety Code,
through the use of telehealth, as defined in Section 2290.5 of the
Business and Professions Code, shall be considered a billable
encounter under Medi-Cal.
(d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, and make specific this section
by means of all-county letters, provider bulletins, and similar
instructions.
(e) On or before January 1, 2017, the department shall report to
the Legislature the number and type of services provided, and the
payments made related to the application of store and forward
teledentistry as provided, under this section as a Medi-Cal benefit.
(f) For purposes of this section, the following definitions apply:
(1) "Asynchronous store and forward" means the transmission of a
patient's dental information from an originating site to the health
care provider at a distant site without the presence of the patient.
(2) "Distant site" means a site where a health care provider who
provides health care services is located while providing these
services via a telecommunications system.
(3) "Health care provider" means a person who is licensed under
Chapter 4 (commencing with Section 1600) of Division 2 of the
Business and Professions Code.
(4) "Originating site" means a site where a patient is located at
the time health care services are provided via a telecommunications
system or where the
asynchronous store and forward service originates.
(5) "Synchronous interaction" means a real-time interaction
between a patient and a health care provider located at a distant
site.
(6) "Teledentistry" means the mode of delivering dental health
care services and public dental health via information and
communication technologies to facilitate the diagnosis, consultation,
treatment, education, care management, and self-management of a
patient's dental health care while the patient is at the originating
site and the dental health care provider is at a distant site.
Teledentistry includes synchronous interactions and asynchronous
store and forward transfers.
(7) "Teledentistry by store and forward" means an asynchronous
transmission of dental information to be reviewed at a later time by
a licensed dentist at a distant site, where the dentist at the
distant site reviews the dental information without the patient being
present in real time.
SEC. 7. Section 1910.5 is added to the
Business and Professions Code , to read:
1910.5. (a) For the purposes of this section, the following
definitions shall apply:
(1) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
(2) "Course" means a committee-approved course preparing
registered dental hygienist to perform the duties described in
subdivision (b).
(3) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
through electronic media, home study materials, or live lecture
methodology if the provider has submitted that content to the
committee for approval.
(4) "Interim therapeutic restoration" means a direct provisional
restoration placed to stabilize the tooth until a licensed dentist
diagnoses the need for further definitive treatment.
(5) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods.
(6) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(7) "Program" means a committee-approved registered dental
hygienist educational program.
(b) A registered dental hygienist may perform both of the
following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
paragraph (4) of subdivision (a), that compromise the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary. The protective restorations shall be placed only in
accordance with both of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c) The functions described in subdivision (b) may be performed by
a registered dental hygienist only after completion of a program
that includes training in performing those functions, or after
providing evidence, satisfactory to the committee, of having
completed a committee-approved course in those functions.
(1) A registered dental hygienist who has completed the prescribed
training in the Health Workforce Pilot Project #172 established by
the Office of Statewide Health Planning and Development pursuant to
Article 1 (commencing with Section 128125) of Chapter 3 of Part 3 of
Division 107 of the Health and Safety Code shall be deemed to have
satisfied the requirement for completion of a course of instruction
approved by the committee.
(2) In addition to the instructional components described in
subdivision (d) or (e), a program shall contain both of the
instructional components described in this paragraph:
(A) The course shall be established at the postsecondary
educational level.
(B) All faculty responsible for clinical evaluation shall have
completed a one-hour methodology course in clinical evaluation or
have a faculty appointment at an accredited dental education program
prior to conducting evaluations of students.
(d) A program or course to perform the duties described in
paragraph (1) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency making decisions about which radiographs
to take to facilitate an evaluation by a dentist, but shall in no
event be less than six hours, including at least two hours of
didactic training, at least two hours of guided laboratory simulation
training, and at least two hours of examination using simulated
cases.
(2) Didactic instruction shall consist of instruction on both of
the following topics:
(A) Guidelines for radiographic decision making prepared by the
American Dental Association and other professional dental
associations.
(B) Specific decisionmaking protocols that incorporate information
about the patient's health and radiographic history, the time span
since previous radiographs were taken, the availability of previous
radiographs, the general condition of the mouth including the extent
of dental restorations present, and visible signs of abnormalities,
including broken teeth, dark areas, and holes in teeth.
(3) Laboratory instruction shall consist of simulated decision
making using case studies containing the elements described in
paragraph (2). There shall be at least one instructor for every 14
students who are simultaneously engaged in laboratory instruction.
(4) Examination shall consist of decisionmaking where students
make decisions and demonstrate competency to faculty on case studies
containing the elements described in paragraph (2).
(e) A program or course to perform the duties described in
paragraph (2) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency in the application of protective
restorations, including interim therapeutic restorations, but shall
in no event be less than 16 clock hours, including at least four
hours of didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training.
(2) Didactic instruction shall consist of instruction on all of
the following topics:
(A) Pulpal anatomy.
(B) Theory of adhesive restorative materials used in the placement
of adhesive protective restorations related to mechanisms of bonding
to tooth structure, handling characteristics of the materials,
preparation of the tooth prior to material placement, and placement
techniques.
(C) Criteria that dentists use to make decisions about placement
of adhesive protective restorations including all of the following:
(i) Patient factors:
(I) The patient's American Society of Anesthesiologists Physical
Status Classification is Class III or less.
(II) The patient is cooperative enough to have the restoration
placed without the need for special protocols, including sedation or
physical support.
(III) The patient, or responsible party, has provided consent for
the procedure.
(IV) The patient reports that the tooth is asymptomatic, or if
there is mild sensitivity to sweet, hot, or cold that the sensation
stops within a few seconds of the stimulus being removed.
(ii) Tooth factors:
(I) The cavity is accessible without the need for creating access
using a dental handpiece.
(II) The margins of the cavity are accessible so that clean
noncarious margins can be obtained around the entire periphery of the
cavity with the use of hand instruments.
(III) The depth of the lesion is more than two millimeters from
the pulp on radiographic examination or is judged by the dentist to
be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic.
(IV) The tooth is restorable and does not have other significant
pathology.
(D) Criteria for evaluating successful completion of adhesive
protective restorations including all of the following:
(i) The restorative material is not in hyperocclusion.
(ii) There are no marginal voids.
(iii) There is minimal excess material.
(E) Protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations including
situations requiring immediate referral to a dentist.
(F) Protocols for followup of adhesive protective restorations.
(3) Laboratory instruction shall consist of placement of adhesive
protective restorations where students demonstrate competency in this
technique on typodont teeth.
(4) Clinical instruction shall consist of experiences where
students demonstrate competency in placement of adhesive protective
restorations under direct supervision of faculty.
(f) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 8. Section 1910.5 is added to the
Business and Professions Code , to read:
1910.5. (a) For the purposes of this section, "interim
therapeutic restoration" means a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment.
(b) A registered dental hygienist may perform both of the
following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
subdivision (a), that comprise the removal of soft material from the
tooth using only hand instrumentation, without the use of rotary
instrumentation, and subsequent placement of an adhesive restorative
material. Local anesthesia shall not be necessary. The protective
restorations shall be placed only in accordance with both of the
following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c) The functions described in subdivision (b) may be performed by
a registered dental hygienist only after completion of a program
that includes training in performing those functions, or after
providing evidence, satisfactory to the committee, of having
completed a committee-approved course in those functions.
(d) This section shall become operative on January 1, 2018.
SEC. 9. Section 1926 of the Business
and Professions Code is amended to read:
1926. A registered dental hygienist in alternative practice may
perform the duties authorized pursuant to subdivision (a) of Section
1907, subdivision (a) of Section 1908, and
subdivisions (a) and (b) of Section 1910 , and Section 1926.05
in the following settings:
(a) Residences of the homebound.
(b) Schools.
(c) Residential facilities and other institutions.
(d) Dental health professional shortage areas, as certified by the
Office of Statewide Health Planning and Development in accordance
with existing office guidelines.
SEC. 10. Section 1926.05 is added to the
Business and Professions Code , to read:
1926.05. (a) For the purposes of this section, the following
definitions shall apply:
(1) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
(2) "Course" means a committee-approved course preparing
registered dental hygienist in alternative practice to perform the
duties described in subdivision (b).
(3) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
through electronic media, home study materials, or live lecture
methodology if the provider has submitted that content to the
committee for approval.
(4) "Interim therapeutic restoration" means a direct provisional
restoration placed to stabilize the tooth until a licensed dentist
diagnoses the need for further definitive treatment.
(5) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods.
(6) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(7) "Program" means a committee-approved registered dental
hygienist in alternative practice educational program.
(b) A registered dental hygienist in alternative practice may
perform both of the following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
paragraph (4) of subdivision (a), that compromise the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary. The protective restorations shall be placed only in
accordance with both of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c) The functions described in subdivision (b) may be performed by
a registered dental hygienist in alternative practice only after
completion of a course or program that includes training in
performing those functions, or after providing evidence, satisfactory
to the committee, of having completed a committee-approved course in
those functions.
(1) A registered dental hygienist in alternative practice who has
completed the prescribed training in the Health Workforce Pilot
Project #172 established by the Office of Statewide Health Planning
and Development pursuant to Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107 of the Health and
Safety Code shall be deemed to have satisfied the requirement for
completion of a course of instruction approved by the committee.
(2) In addition to the instructional components described in
subdivision (d) or (e), a program shall contain both of the
instructional components described in this paragraph:
(A) The course shall be established at the postsecondary
educational level.
(B) All faculty responsible for clinical evaluation shall have
completed a one-hour methodology course in clinical evaluation or
have a faculty appointment at an accredited dental education program
prior to conducting evaluations of students.
(d) A program or course to perform the duties described in
paragraph (1) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency making decisions about which radiographs
to take to facilitate an evaluation by a dentist, but shall in no
event be less than six hours, including at least two hours of
didactic training, at least two hours of guided laboratory simulation
training, and at least two hours of examination using simulated
cases.
(2) Didactic instruction shall consist of instruction on both of
the following topics:
(A) Guidelines for radiographic decision making prepared by the
American Dental Association and other professional dental
associations.
(B) Specific decisionmaking protocols that incorporate information
about the patient's health and radiographic history, the time span
since previous radiographs were taken, the availability of previous
radiographs, the general condition of the mouth including the extent
of dental restorations present, and visible signs of abnormalities,
including broken teeth, dark areas, and holes in teeth.
(3) Laboratory instruction shall consist of simulated decision
making using case studies containing the elements described in
paragraph (2). There shall be at least one instructor for every 14
students who are simultaneously engaged in laboratory instruction.
(4) Examination shall consist of decisionmaking where students
make decisions and demonstrate competency to faculty on case studies
containing the elements described in paragraph (2).
(e) A program or course to perform the duties described in
paragraph (2) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency in the application of protective
restorations, including interim therapeutic restorations, but shall
in no event be less than 16 clock hours, including at least four
hours of didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training.
(2) Didactic instruction shall consist of instruction on all of
the following topics:
(A) Pulpal anatomy.
(B) Theory of adhesive restorative materials used in the placement
of adhesive protective restorations related to mechanisms of bonding
to tooth structure, handling characteristics of the materials,
preparation of the tooth prior to material placement, and placement
techniques.
(C) Criteria that dentists use to make decisions about placement
of adhesive protective restorations including all of the following:
(i) Patient factors:
(I) The patient's American Society of Anesthesiologists Physical
Status Classification is Class III or less.
(II) The patient is cooperative enough to have the restoration
placed without the need for special protocols, including sedation or
physical support.
(III) The patient, or responsible party, has provided consent for
the procedure.
(IV) The patient reports that the tooth is asymptomatic, or if
there is mild sensitivity to sweet, hot, or cold that the sensation
stops within a few seconds of the stimulus being removed.
(ii) Tooth factors:
(I) The cavity is accessible without the need for creating access
using a dental handpiece.
(II) The margins of the cavity are accessible so that clean
noncarious margins can be obtained around the entire periphery of the
cavity with the use of hand instruments.
(III) The depth of the lesion is more than two millimeters from
the pulp on radiographic examination or is judged by the dentist to
be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic.
(IV) The tooth is restorable and does not have other significant
pathology.
(D) Criteria for evaluating successful completion of adhesive
protective restorations including all of the following:
(i) The restorative material is not in hyperocclusion.
(ii) There are no marginal voids.
(iii) There is minimal excess material.
(E) Protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations including
situations requiring immediate referral to a dentist.
(F) Protocols for followup of adhesive protective restorations.
(3) Laboratory instruction shall consist of placement of adhesive
protective restorations where students demonstrate competency in this
technique on typodont teeth.
(4) Clinical instruction shall consist of experiences where
students demonstrate competency in placement of adhesive protective
restorations under direct supervision of faculty.
(f) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 11. Section 1926.05 is added to the
Business and Professions Code , to read:
1926.05. (a) For the purposes of this section, "interim
therapeutic restoration" means a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment.
(b) A registered dental hygienist in alternative practice may
perform both of the following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
subdivision (a), that compromise the removal of soft material from
the tooth using only hand instrumentation, without the use of rotary
instrumentation, and subsequent placement of an adhesive restorative
material. Local anesthesia shall not be necessary. The protective
restorations shall be placed only in accordance with both of the
following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c) The functions described in subdivision (b) may be performed by
a registered dental hygienist in alternative practice only after
completion of a course or program that includes training in
performing those functions, or after providing evidence, satisfactory
to the committee, of having completed a committee-approved course in
those functions.
(d) This section shall become operative on January 1, 2018.
SEC. 12. Section 14132.725 of the
Welfare and Institutions Code is amended to read:
14132.725. (a) Commencing July 1, 2006, to
To the extent that federal financial participation is
available, face-to-face contact between a health care provider and a
patient shall is not be
required under the Medi-Cal program for teleophthalmology
and , teledermatology , and
teledentistry by store and forward. Services appropriately
provided through the store and forward process are subject to billing
and reimbursement policies developed by the department.
(b) For purposes of this section, "teleophthalmology and
, teledermatology , and teledentistry
by store and forward" means an asynchronous transmission of medical
or dental information to be reviewed at a later time by a
physician at a distant site who is trained in ophthalmology or
dermatology or, for teleophthalmology, by an optometrist who is
licensed pursuant to Chapter 7 (commencing with Section 3000) of
Division 2 of the Business and Professions Code, or a dentist,
where the physician or ,
optometrist , or dentist at the distant site reviews the
medical or dental information without the patient being
present in real time. A patient receiving teleophthalmology
or , teledermatology , or teledentistry
by store and forward shall be notified of the right to receive
interactive communication with the distant specialist physician
or , optometrist, or dentist
and shall receive an interactive communication with the distant
specialist physician or , optometrist,
or dentist, upon request. If requested, communication with
the distant specialist physician or ,
optometrist , or dentist may occur either at the time of
the consultation, or within 30 days of the patient's notification of
the results of the consultation. If the reviewing optometrist
identifies a disease or condition requiring consultation or referral
pursuant to Section 3041 of the Business and Professions Code, that
consultation or referral shall be with an ophthalmologist or other
appropriate physician and surgeon, as required.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, and make specific this section
by means of all-county letters, provider bulletins, and similar
instructions.
(d) On or before January 1, 2008, the department shall report to
the Legislature the number and type of services provided, and the
payments made related to the application of store and forward
telehealth as provided, under this section as a Medi-Cal benefit.